Case Study
John is a 45-year-old male who presents to your clinic complaining of fatigue, depressed mood and ongoing gastro-intestinal symptoms. Over the last 12 months, John has been experiencing a yellow discolouration to his stools, which are malodours and float. John experiences bloating and a feeling of “heaviness” after meals, and has a tendency towards constipation (passes a stool once every other day). He was diagnosed with gastro oesophageal reflux disease 3 years ago, which is managed successfully with Nexium (1 x 20 mg/d tablet).
John has a stressful job as a project manager and feels completely “wiped out”. He has no difficulty with sleep onset and sleeps for approximately 6 – 7 hours per night however, wakes up feeling unrefreshed. John explains that he feels irritable and short-tempered, especially when he comes home after work. Despite this, John exercises at the gym 5 – 6 days per week. Over the last 3 months he has found it increasingly difficult to stay motivated due to the fatigue and depressed mood.
A routine check-up with his doctor one month ago found no abnormalities in any of the screening blood tests (liver function, full blood count, iron studies) and has been referred for an endoscopy for further investigation.
Family history
Maternal side
Mother: Type II diabetes
Grandmother: Dementia (passed away age 76) Grandfather: Passed away of natural causes age 89
Paternal side
Father: Diverticulitis Grandmother
Irritable bowel syndrome (passed away age 84) Grandfather: Hypertension (passed away age 75)
Physical examination
Skin: NIL
Nails: Pronounced vertical ridging
Tongue: Pale colour, light coat with a quiver
Zinc Tally Test: Very slight metallic taste after 10 seconds Weight: 85 kg
Height: 175 cm BP: 140/90 mmHg
Heart rate: 76 BPM
Current typical diet Breakfast
1 x cup of rolled oats with cow’s milk 1 x long black coffee
Snack
1 X large blueberry muffin 1 x 600 mL bottle of water
Lunch
1 x hamburger (from cafeteria) with a beef patty, lettuce, 2 slices of tomato, 1 slice of cheese, 2 slices of cucumber, 1 slice of onion, 1 slice of beetroot, 1 fried egg
1 x 600 mL bottle of water
Snack
1 x piece of fruit (usually a banana or an orange)
Dinner
2 x lamb chops with 1/2 cup of frozen peas and corn; 1 cup mashed potato (mashed with milk and butter), 1 cup of boiled broccoli, 1 cup of zucchini
1 x 600 ml bottle of water
Dessert
3 x scoops of vanilla ice cream
Medications
1 x 20 mg tablet / day of Nexium
